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� �►� `1°i�,e S i 0 nrr UPC 12543 % �a NOS ` rn HASTINGS. MN PRESS pE� wn of Barnstable *Permit# X 0 !�Oq Expires 6 ma from issue date UN 2 4 201 Regulatory Services Fee 3 hima Thomas F.Geiler,Director OF BARNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barmtable.ma.us Fax: 508-790-6230 Office: 508-862-4038 RESIDENTIAL ONLY EXPRESS PERMIT APPLICATION - Not Vatid without Red X--Press Imprint Map/parcel Number Z Property Address minimum fee of$35.00 for work under$6000.00 Residential Value of Work Owner's Name&Address /G ` Telephone Number Contractor's Name Email. Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ensation Insurance . ❑ I have Worker's Comp Insurance Company Name Workman's Comp.Policy# each ermit. Copy of Insurance Compliance Certificate must accompany P Permit Re uest(check box) nailed) (stripping old shingles) All construction debris will be taken to c t N Re-roof(hurricane ❑ G Re-roof(hurricane nailed)(not strife g• Going over existing layers of roof) ❑ Re-side (maximum.35)#of windows ❑ Replacement Windows/doors/sliders.U-Value #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required.Hance with other town department regulations,i.e.Historic,Conservation,etc. *where required: Issuance of this permit does not exempt comp ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of th Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: . Q:\WPFILES\FO S\building p it forins\EXPRFSS.doc Revised 060513 s A The Commonweahb of Massachusetts Deparbsnent of Indusdzal Accidents OOk-e of Investigations 10 600 Washington,Street Boston,MA 02111 www mas&gov/dia Workers' Compensafiou Insurance Affidavit_Builders/Contractors/ElectricianslPlumbers Applicant Information Please Print 1*6bh , 1 2 -74 Address: /City/Stat&Zip: i Phone# O o � 00 / Are you an employer?Check the appropriate box: 1.❑ I am a 1 with 4- ❑ I am a general contractor and I Type of protect(required):�P employees(full and/or part-time)-* have hired the sub-contractors 6. ❑New construction 2_❑ I am a sole proprietor or partner- listed on the attached sheet_ 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition wading for me in any capacity employees and have wa dcers' [No workers' comp.insurance comp_insuraoml 9. ❑Building addition ` ` 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions reed] officers have exercised their 3_ am a homeowner doing all waoic 11.❑Plumbing repairs or additions / myself [No wormers'camp. right of exemption per MGL 12XRoof repairs insurance required,]i c-152, §1(4�and we have no employees.[No worloers' 13.0 Other vcomp-insurance required.] •Any appticaot tat checks bra#1 mast 21so fill out the section below showing 8ua wodkers'compensation policy udbrmatioa_ 7 Mmaeownes who submit this affidavit umbcating they are doing all word.and then hfre outside caattacton— submit a new affidwit.indicatmg such_ tCoutmctm that cbea this bra must attached au additional sheet shoring the name of the sob-conbuUes sad state whether ornot those emities brae emphryees. If the snb-caotmctats have moplogees,they roar piavide their workers'comp.policy omaber. I ant an employer that is providurg workers'compensation insurance for my employers. Bsdow is the policy and job sins information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the poficy number and expiration date). Failure to secure coverage as requited under Section 25A ofMGL a..152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Eke of p to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification- AT do;hsraby un&r ' s attics ofpailwy that the inforrnation powti&d above is an torero 1 Date: Phone#: Ofi'cial use only. Do not write in.this area,to he completed by city or totwr gj(jtciat City or Town: Permit/License# Issue Authority(drele one): 1.Board of Health .2.Building Department 3.City/Town Clerk 4.Electrical'Inspector 5.Plumber Inspector 6.Other Contact:Person: Phone& 6 of TME • IARNSTABLE, • MASS. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division > Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder T , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit, please.complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content0udook\QRE6ZUBN\E)MRESS.doc Revised 053012. of� Town of Barnstable Regulatory Services BARNST'"HLF, ' Thomas F.Geiler,Director 39. & Building Division ' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION + Please Print )B LOCATION: number street village name home phone# work phone# URRENT MAILING ADDRESS: 7 city/town state zip code be current exemption for"homeowners"was extended to include owner-occUied dwellings of six units or less and to allow omeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER erson(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- imily dwelling,attached•or detached structures accessory to such use and/or farm structures. A person who constructs more than one ome in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form :ceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 09.1.1) he undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, ylaws,rules and regulations. he un igned"h a wner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection ro a es and re is and that he/she will comply with said procedures and requirements. e 0 oydeF 6pproval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code -ction 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt" •om the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors); provided that if the homeowner igages a persons)for hire.to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor ee Appendix.Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often :suits in serious problems, particularly when the homeowner hires unlicensed persons. In this case,.our Board cannot roceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is Itimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the !rmit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page r this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use-in )ur community. \Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc evi'sed 053012. Town of Barnstable *Permit# P� Expires month issue date Regulatory Services Fe i • 9ARNSrABLE. Thomas F.Geiler,Director / 9 MASS. 039. ]Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us - Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ��� Pc l4Eij AResidentia-l Value of Work S�J� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Rf/-/L--l7=_ -2cJ Pr ti-t!C Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ®R-PRESS PERMIT ❑ I am a sole proprietor Ii- 2_.,I am the Homeowner ❑ I have Worker's Compensation Insurance AUG 1 9 2008 Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side i ❑ 'Replacement Windows/doors/sliders.U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. k I?P51A':0 < SIGNATURE• H : 1 HJV 61 1j,*i!H0Cz- . D-i0'-'! r 'tl s'a r i; `CI�i .i.,1 . .. Q:Forms:buildingpermits/express Revised 123107 The Commonwealth of Massachusetts Department o Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 ., www.mass.gov/dia ' Workers}Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): � /G l �Y � ►� +°� , Address: City/State/Zip:GV l � �3C�Phone.#: Are.you an employer? Check the appropriate box: :Type of project(required):. i.❑ I am a employer with 4. ❑ I am a general contractor and I , have hired the sub-contractors 6• ❑New construction . employees(full and/or part time).* Remodeling 2.❑ I am a•sole proprietor or partner- listed on the'attached sheet �• ❑ g ship and have no employees These sub-contractors have g• ❑Demolition 'working for me in any capacity. employees and have workers' 9• ❑Building addition [No workers' comp,insurance comp. insurance.#' 5 ❑ We are a corporation and its 10.❑Electrical repairs or additions . required.] ' 3. I am a homeowner doing all-work . officers have exercised their 11.❑Plumbing repairs or additions ' myself.[No workers' comp. right df exemption per MGL 12•❑Roof repairs insurance.required.]t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provi&their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investi ations of tbt DIA for insurance coverage verification. I do hereby ce i nder the pains and penalties of perjury that the information provided above is true nd correct. Si afore• Date: Phone# Official use only. Do not write in this area, to be completed by,city or town off cial. Permit/License# City or Town: Issuing Authority(circle one): .1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth-for any applicant who has not produced,acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter..152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall `enter into any contract for.the performance of public work until acceptable evidence of compliance with:tlie insurance- requirements of this chapter have been presented"to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information.(if necessary)and under"Job Sife Address"the applicant should write"all-locations in (city'or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address;telephone-and fax number. The Coixzmmwealth of M.assaehusetts l7epartmimt of ludustdal A.ccidemts Office ofn�estgatxous - 600 Washingtdi'i Street u B.oston,.MA 02111 . . T'QL #617-727-450.0 ext 406 or 1-877-MASS-AFE Fax#617-727-7749 Revised 11-22-06 ' www.matss.gov/dia e • ' I Town of Barnstable �0F'CHE o) Regulatory Services Thomas F.Geiler,Director • BARNSTABLE. • , MAS&. Building Division �pTEo J�.tA'1 awe g Tom Perry,Building Commissioner 200 Main Street•, Hyannis, MA 02601 www.town.barnstable.malus Office: 508-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: .2`Z s-� ��.r.Gt✓ �� t� �9��5 J�Gam' JOB LOCATION: number street d �p village ..HOMEOWNER": name home phone# work phone# CURRENT MA1LiNG ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to' be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a iwo-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations: The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department um inspection procedures and requirements and that he/she will comply with said procedures and r4 q ements. aturc of cwwner Approval of Building Official I Note: Three-family dwellings containing 35,000 cubic feet or larger will be,required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perfomung work for which a building permit is required shall be exempt from the provisions of this section(Section i og.1.1-Licensing of constivction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption aie unaware that they are assuming the responsibilities oCa supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, nbilitics of a Supervisor. On the last page of this issue is a form currently used by that the homeowner certify that he/she understands the rrspon several towns. You may care t amend and adopt such a form/certification for use in your community. °F'fHET � Town of Barnstable Regulatory Services u"ST"BLE• Thomas F. Geiler,Director ri A CQ l _ r�oMt,�X Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 509-962-403 8 Fax: 508-790-623 0 Property Owner Must � Coimplete>and-Sign This,Section �. If Using A Builder L , as Owner of the subject property hereby authorize to act on my behalf, in all.matters relative to work authorized by this building permit application for: (Address off ob) Signature of Owner Date Print Name If Property Owner is.applying for permit please complete the Homeowners licens e Exemption Form on the reverse side. o-d ro��-36 i Town of Barnstable *Permit# �pFTHE rOiy� Expires 6 monthsfrom issue date Regulatory Ser.:viees iaxtrsrAsre; Thomas F. Geiler,Director 7 T"M mD. ,639. Building Division n1III PTFo rya Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 7/ �✓ 1 www.town.bamstable.ma.us Fax: 508-790-6230 _ Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 6 Property Address � ��� ` UV " — ❑ Residential Value of Work � Minimum fee of$25.00 for work under $6000.00 Owner's Name&Address PV/-/� Contractor's Name Telephone Number Home Improvement Contractor License# (if applicable) n����� Mff ❑Workman's Compensation Insurance 2008 Check one: AUG _ 8 I am a sole proprietor I am the Homeowner TOWN! OF BARNSTABLE- ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of insurance Compliance-Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side e- Replacement Window doors/ iders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. 'Note: Property Owner must sign.Property.Owner Letter of Permission. A copy of the Dome Improvement Contractors License is required. I i SIGMA r' • t, The Commonwealth of Massachusetts Department of Industrial Accidents Office of 1-nVi estigatlons 600 Washington Street Boston, MA 02111 www.mass.gov/dia kvi Workers' Compensation Insurance Affidavit: Builders/Contractors/Electric' Pri lumbers "Appficant Information Please Print Le 'bI Name (Business!Organization/Individual): ;P,4/L✓p Address: 2-75 ,1A-AE 7 i oaf o �7,f/0 City/State/Zip: /�(,�.L3,aj2•���'9- ' LEAS Phone.#: Z Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4- ❑ I am a general contractor and I 6 ❑New construction employees (full and/or part-time).* lave hired the shb-contractors 2.❑ I am a'sole praprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition [No workers' CQ�.-mgTranr_e comp.mein-ance.t 5. ❑ We arc a corporation and its 10.0-Electrical repairs or additior 3)rtgmred.] officers have exercised their 11.❑Plumbing repairs or addition I am a homeowner doing all work //myself [No workers' comp. rigbt exemption per 12 ❑Roof repairs incvrancc r t c. 152, §1(4), and we havee n no - �� employees. [No workers' 13.❑ Other comp,insurance required.] *Any applicant that cheelz box#1 must also fill out the section below sbowing their work 'compcas4on Policy information t San=wnert who eubsat this a$idavit indicating tbey an:doing all work and tbrn hire outside cant roars must subm ait uew affidavit indicating ttteh tContraetDrs that check this box must zdachcd an additional sheet showing the name of the sub cuntraehors and slats whether or not tbost entities have employees. If the sub-eoniraetnrs have anPloycer,they must providt their workers'comp-policy number. I am an employer that is providing work--rs'compensation insurance for my employees. Below is the policy and job site information. Insurance Company!dame: Policy#or Sclf--ins.Lic.#: Expiration Data: fob site Address: City/SlatrJZip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date; Failure to secure coverage as requuzd under Section 25A of MGL c. 152 can lead to the imposition of criMilial penalties of. fins tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a f of up to$250.00 a day against the violator. Be advised that a copy of this stat,crit may be forwarded to the Office of esti lions of the DIA for insurance coycrago verification_ Ida her c under the pains-and penalties of perjury thert the informwYon provided abov#ju e�janl correct S• e. Datt- D fish!use only. Do not write in this area, fo be comp121ed by city or!own offtciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Town of Barnstable �oF'[HE r�ti .. Regulatory Services . y saxry Thomas F.Geiler,Director 4 MAIM b Buildin Division $PjFD MI`�Awe Tom Perry,Building Commissioner 200 Main Street; Hyannis, MA 02601 K-ww.town.barnstabl e.ma:us Office: 508-862-4038 Fax: 5.08-790-6230 HONSO WNER LICENSE EXEMPTION Please Print DATE: ! r JOB LOCATION: 075 P1/-�F number street 0lage ./ �J�' �Zd2go boa. moo• e085 "HOMEOWNER":?��eGl� G /"— name home phoncc## work phone# (CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to- be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for.compliance with the State Building Code and other applicable codes, bylaws,rules and regulations: The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department . um inspectio pros d e""s and requirements and that he/she will comply with said procedures and re ements. i i a re o 0 owner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be.required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perfomung work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption arc unaware that they are assuming the responsibilities oCa supervisor(sec Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons_ In this case,our Board cannot proceed against the unlicensed person as it would With a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. °pTHEt, Town of Barnstable Regulatory Services BARNSTABLE, ' Thomas F. Geiler,Director rEonea'� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using'A Builder as Owner of the subject property hereby authorize to act on my behalf, in all.matters relative to work autho d by this building permit application for: (Address of job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. FRIEDLINE&CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: ('U Building Commissioner or Inspector of Buildings ( )Board of Health or Board of Selectmen ( ) Fire Department TOWN-OF,Barnstable TOWN HALL Hyannis, MA RE: Insured: WALLACE, Lesley Property Address: 275 Pine Street W. Barnstable, MA Policy Number: FP070078 Type of Loss: Fire Date of Loss: 2/27/2006 File#: 104212 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed$1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 36 is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail. P. J. PARECE Adjuster 3/14/2006 TOWN OF BARNSTABLE DEPARTMENT OF HEALTH SAFETY AND ENVIRONMENTAL SERVICES BUILDING DIVISION STOP WORK THI S STRUCTURE AND/OR PREMISES HAS BEEN . INSPECTED AND THE FOLLOWING VIOLATIONS OF THE BUILDING CODE AND/OR ZONING ORDINANCE HAVE BEEN FOUND: 3) 4) YOU ARE HEREBY NOTIFIED THAT NO ADDITIONAL WORK SHALL BE UNDERTAKEN > UPON THESE PREMISES, OR THE PREMISES OCCUPIED UNTIL THE ABOVE VIOLATIONS ARE CORRECTED. ANY PERSON REMOVING THIS NOTICE WITHOUT PROPER AUTHORIZATION SHALL BE LIABLE TO A FINE OF NOT LESS THAN FIFTY, NOR MORE THAN ONE HUNDRED DOLLARS. Address -7 �` 4 ft� S T L z 4 Date = � 1 " Building CCmninissioner TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z Parcel � ' ICJ Permit# Health Division Date Issued 'c? Conservation Division 2,0 c Fee �� t Tax Collector SEPTI C IC SYSTEM MU S BE 1 U 3 INSTALLED IN COMPLIANCE Treasurer WITH TITLE 5 ENVIRONMENTAL CQDE AN� Planning Dept. TOWN REGULAT ke in By Date Definitive Plan Approve 9eservation/Hyannis TV B�o�ard Approved By Historic-OKH w9d, Project Street Address Z 75 P Lx,e2zE ST Village Lam' Owner ZjE.SLo ZF!��/447> Address Telephone ar,?Q�. �(02 26 Permit Request gff&ZLQ t _ Square feel st floor: existing proposed 2nd floor: existing proposed i Total new Valuation ��"9� Zoning District Flood Plain Groundwater Over,- < ; Construction Type Lot'8ize Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure44D Historic House: El Yes YNo On Old King's High ay: kes U No Basement Type: ❑Full O Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 2 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing _j new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: Cl Gas -AOil ❑Electric ❑Other Central Air: ❑Yes ;XNo Fireplaces: Existing y" New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage:Cl existing ❑new size Shed:❑existing ❑new size Other: C.-&Q 'b Q T' IQ Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial O Yes ).No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number fkzo Address?`�''7� � `® License# 1= _ - (L— Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO � � SIG NATUR ATEZ/__a X5 FOR OFFICIAL USE ONLY PERMIT NO. PATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER • r DATE OF INSPECTION: a FOUNDATION n„ ` m N FRAME ~¢ t7C n INSULATION FIREPLACE r n Q ELECTRICAL: 'ROUGH FINAL ' . PLUMBING: �ROUGH;�' FINAL ci GAS: ROUGH FINAL7. FINAL BUILDING DATE CLOSED OUT �. ASSOCIATION PLAN NO. The Commonwealth of Massachusetts i Department of Industrial Accidents Office.of Investigations 600 Washington Street Boston,MA 02111 •'i www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunmers Avylicant Information Please Print Legibly Name (Business/orpmzation/Individual): -P •1 L l • t�L 1. Address: City/State/Zip: E'S tJ Phone Are you an employer? Check the-appropriate bog:. Type of project(required):• 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t ? Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any ca aci workers' comp.insurance. 9. p ty. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or.additions � �] officers have exercised their 3. am a homeowner doigg all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no. 12.❑ Roof repairs insurance required.]t employees. [No workers` 13. Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: `e t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infonrratiou. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site. information.Insurance.Company Name: Policy#or Self-ins.Lic. #: Expiration Dater Job Site Address: City/State/Zip. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can'lead to the imposition of criminal penalties of a fine up to$1,500,.00 and/or one-year imprisonment, as well as.civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to.the Office of . Investigations of the DIA for insurance coverage verification. I do hereby cerli er the pains enalties of perjury that the information provided above true d correct: Si afore: Date:'. Phone#: Z Official use only. Do not write in this area,to be completed by city.or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions L ; Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. pursuant to this statate, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written. association,Farporation or other legal entity,or any two or more An employer is defined a$•.:aa ipdiyi¢lial,.:PaerslliP�, of the foregoing-engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver.or trustee of an individual,Partnership, association or other legal entity, employing employees. Howcver: e owner of a dwelling house having not more than three apartments and wI o resides therein,or.the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair wofkvu such dwelling house appurtenant thereto shall not because of such employment be deemed to be an employer or on the grounds or building ." MGL chaptei'152,§25C(6)also states that"'every state or local licensing agencyshall withhold the issuance or MGLTene c l of a license or permit to operate 'business or to construct buildings in the coriimonweAli for any applicant who has not produced acceptable evidence-of compliance with the insurance coverage required."_ Additionally,MGL chap §25C ter states `Neither the commonwealth nor any of its,political subdivisions shall .. 152, (� enter into any contract for the performance of public work until acceptable.'evidence of compliance with the insurance requirements of-this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if. necessary,supply sub-contractors)name_(s),address(es) and phone number(s)along with their certifieate(s) of , )or Limited Liability Partnerships(LLP)with no employees other than the insurance. Limited Liability Companies(LLC members,or partners$ are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,apolicy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure-to sign and date the affidavit. The affidavit should be returned to the city or sown that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' ationpolicy,please call Department ll the Dtment at the number listed below. Self-insured . companies should enter their compens self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference mimber. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"'the applicant should write"all locations in (city or 0�rn)."A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that.a valid affidavit is-on file for:future permits or-licenses..Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts Department of Industrial Accidents ..Office of Investigations r. 600-WashingtonS reet� . r Boston,MA 02.111. Tel. #617-7.27-4900 ext 406 or 1-877-MASSAFE Fax#617-7274749 Revised 5-26-05 www,mass.gov/dia °FINE t Town of Barnstable .Regulatory .Services STABLE, ; Thomas F.Geiler,Director 9 MAW. `bp,Ep 9.,a`0 Building Division Tom Perry,Building Comriussioner 200 Main Street; Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with'other. requirements. Type of Work:� Estimated Cost-07 Address of Work: Owner's Name. cc� Date of Application: I hereby certify that: Registration is not required for the following reason(s): 0Work excluded by law ❑Job Under$1,000. Building not owner-occupied er pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: > Date Contractor Name Registration No. 2 D5F,04/7> Date Owner's Name Q:forms:homeaffidav , r I I I t I f I I i ' I i I I , I , � . ...... . ..:. .. ..... : i - D , , x ^t , I I i , i Q� : , , , i I I f i i , I , , I UN I ' , a ' t , _ 1 low UA , I , I ! , I 44 bwo cr , • I i I I : I I , I ' f --... _ I L. : , I ( I , , I N.. I ;. , , i • : I =. I I i i I I i r ti. , �-- FLOOP, OAAZ 1) 0 t C, WO CE E-3 FOP . _ .P : — ! �. : : : o , _ .... E7: I I T I f i i 1 I . . _ .. - _ __ ..+ _. 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' .. r� _ ��� �r ��� �� � �..�i .i . ._ _. 4 �.• � � r _. ...� �' r tl� i � � �0v i Town of Barnstable pFZME Tp� Regulatory Services _ Thomas F.Geiler,Director 039, .0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Tice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print j DATF-*—fb ' JOB LOCATION; / l� -' � vrllage l'�/� number street .1HOMEowNER": tuluT� Gs5 LE G �,cl cis6z 4ec 62 name home phone# work phone# CURRENT MAn.NG ADDRESS: 7 1 c T5© —70 00-1 !IT 00rap city/town state zip code The current exemption for"homeowners"was extended to include owner-occuvied dwellings of six units-o less and to allow homeowners.to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)'who owns'a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all Stich work performed under the building vermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. , The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department ApectI Id ion o ores and requirements and that he/she will comply with said procedures and . owner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code Mates that: "Any homeowner perforrmng work for which a building permit is required shall be exempt from the provisions Of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor:' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. Jn this case,our Board-cannot proceed•against the unlicensed person as it would with a licensed supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. you may care t amend and adopt such a form/certification for use in your community. r `APPlication to: Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings, or photo- graphs accompanying this application. ( y TYPE OR PRINT LEGIBLY DATE AD DRESWOF PROP�SEP r.0RK � ���'� ASSESSORS MAP NO. OWNER CU ASSESSORS LOT NO. ', --- HOME ADDRESS ®� �� TEL. NO.�—CL J`�-'� AGENT OR CONTRACTOR © ✓`��✓ �a� �rU9'I� ADDRESS TEL. NO. This application is for exemption of proposed exterior construction on the ground that: ❑ (1) It will not be visible from any way or public place. ❑ (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot,and, if an addition Is involved, show" ing location of existing building. Space below line for Committee use. . 0 r.• on actOr•Agent Received by H.D.C. The Certificate is hereby . Date Time / By Date Approved Cl The categories of work entitled to exemption are listed on Disapproved ❑ the back of this form. • 1� • Ilk- AL [ • r 1 y A Assessor's map and lot umbe �""'"/SLY,I-.a!�.i►.....� gf rJ�l �. r ;. SE TIC SYSTEM MUST' 'B Se4l,a Permit number ............. !l..Q............••••.•••••••••• INSTALLED IN COMPLIANCE 1Af FTNeT TH ARTICLE II STATE '- TOWN OF BARN GLY F4 r®wN REG�I LA11 ,�"W .-A B9HB9TADLE; i T' ,•a , "b qa0 BUILDING INSPECTOR: s r:7 co �� •.r . t.i i _i rm a APPLICATION;FOR;PERMIT TO ..... ... .......................................................... 0 TYPE OF 'CONSTRUCTION ............1/ `1I.. .. . ............................................................. ... ....................... Ir • \ 1 r. ........................ . ... . . .... ...19.. J: ,TO THE INSPECTOR OF BUILDINGS: rt The. undersigned hereby applies for //a/permit according to the following -information: Location ..........�J, !YI .XYI.r. ....!N ... .� .. .... . . ........... ................................................................................ ProposedUse ......:.. ..�..�....................................................................................................... ZoningDistrict ........... ...................... re District .. ................................................ .......................... I Name of Owner ... s . rL!�.lrf. .. .. . ......... . Address ......... ... ... :.......!Ye�!! ... .................. Nameof Builder ..................................Address ..................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation ................................................................. ...... ........... ... . ... . ..... ...................... Exierior ....................................................................................Roofing ... .............. ... .. ................ Floors ..... •.....Interior ........:.......................................................... ram" Heating ..................................................................................Plumbing ......................................:.......................:................... Fireplace ..................................................................................Approximate Cost .......`j...e Definitive Plan Approved by Planning Board -----------_------_-----------19_______. Area / ..... .................. Diagram of Lot and Building with Dimensions Fee !,:a .. SUBJECT TO APPROVAL OF BOARD OF HEALTH 6 eAyo �J x I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . eXu . ....................................... ` Ciinghau,William J. ' . � . 2Q%Z2' `m tool house No ................. Permit for ------------ � � --------.-----------------. . Pine Street ' Location. ................................................................ � ^ � West Barnstable _ .. .......................................................... � ' �1��1' � � Owner --------.��—.�..��..������.--- ' � frame � Type of Construction .......................................... ^ ' -----,---~.----------------. ` ' Pkot.----'..---. Lot ................................ � � � ��� I� �� Permit Granted ----..--------lA � Date of Inspection ------------l9 - / . Date Completed ---- � .. `�2���---]� � . � % ' ' f � PERMIT REFUSED ' _.----_.-----.--------- l� ' � ` -------------------_.-----.. ' ~ � ..-.--...—....—.—..-----------....— � ^ ..i-.—.—.—.----.---...—.....----... � ' ----.--,—.—..~—.—.—.—.--.—.—.---.— Approved l� ---------------- � ~~ ' � -------------'—~~—^--^^^^~--'' � ..........................................................................�. � � � ` . Assessor's map and lot number ............................... .............. F SC-wage Permit number ............................ ............................. yOFTNET�� TOWN OF BARNSTABLE I MARNSTADLE, i 0�Y.ae�� R1.1110ING INSPECTOR s APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION .................... ..............................:................................................................................... ..................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..........................:.......................::...................: .......::.................................................................................................... ProposedUse ..............:.:............................................................................................................................................................ ZoningDistrict .............................::.........................................Fire District .............................................................................. Nameof Owner .................................... .....::.. ..:::.... ....:.i..Address ............:......................................... .....: ................ Nameof Builder ........................Address....................... .................................................................................... Nameof Architect ..................................................................Address ...........,........................................................................ Numberof Rooms ..................................................................Foundation ......::...................................................................... ExteriorRoofing........................................................ ............................... ................................................ Floors ...........................................................Interior .................................................................................... Heating ................................................:.................................Plumbing .................................................................................. Fireplace .....................................Approximate Cost .......:?.: 1.............................................. ........ .......................................... Definitive Plan Approved by Planning Board -----------____---------------19_______. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH •hereby agree to conform to.all'the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ............................... Clinghan, William J. A=152-16 L '4-L 1 hous 20222 tooV No ................. Permit for ............. ............ ......... .................... ................................. ........ ........ itPine' Street Location ............................................ .. ............... West Barnstable ................................................................. William J. Clinghan Owner .................................................................. ftame Type of Construction ...............,N..::. .............................................a........ ....................... Plot ............................. Lot ................................ May 1�/ 78 Permit Granted ..............................:.........19 4 Date of Inspection ............./......... F.....19 Date Completed .............. ........ .....19 PERMIT REFUSED ....................................................... ...... .. 19 ........... ...... :..... �. ........ ........ ......... ...... ................. .. .. ..... . ....... ... . .............. ................ ................... ........................ Approved ................................................ 19 . ................................................................................... Assessor's_ � � • , map, and lot number` ,�a' �` ......... r .'`...s i TN E.T0� J Q Sewage Permit number?'.;:: .,.l....�-4!.�0-�t!!7e:......•a J— � ��� �,�' �� 411 / ASMann V l ,/ B E. Howenumber ,:.`..:...................................... ............................. - 9� Mann o 3 'F0 MaY a�e TOWN, .0V B•ARNSTABLE D U I L D I H G. !'N S P;E°C`T-0 R APPLICATION FOR PERMIT TO .......�'v► .,.!��f'.! !��............. `` .............................. v TYPE OF CONSTRUCTION .....' !�� ....................,....................................................................................... ........ . .� ./. .,9..s/ TO THE INSPECTOR OF:BUILDINGS: The undersigned hereb y applies for,..a permit according toto the following information- Location �.�.,.. ,/ B� /i!�.® its..... .!7 1 K��. .. !.. ....................... ProposedUse ......... R................................................................... ZoningDistrict ....Fire District . .................................... ............................. i ..................................... ................................. Name of Owner ... /, . ��fil. �tj., ,% ............Address Y/s.ff �.�., % . .!!i./:. .� 1�4,,�+/]/,✓LA Name of Builder ................... .:O.P.Q,/...:...............:............Address ................✓1�h�A!!t {J.. /. ..v!... .�%.� :.......... Nameof Architect ..................................................................Address .....................:.............................................................. Number of Rooms ..................................................................Foundation0lf ..1�11Q ..f'. '1/�/��/JI�11 Exterior ..... � ..... •l•CP,ii.� 1.....................:: :'.:.Roofing ....... .. ... ..1.. !�"...I .1!! .CA1n ........... D V Floors ......... :...........................................Interior' ....... ..................................................... Heating �...Alai '. °.....- .... ............... .....................Plumbing ..7, 1/� ,.%.. ................................... Cost... ......Firlace ... .... ... APPo.xim te � . � . •:.. ............ Definitive Plan Approved by Planning Board ---------------_---------------19_______ . Area ..........Z..��.�.... :f> : ..... Diagram of Lot and Building with Dimensions Fee �......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH /mod t s I hereby agree to conform to all the Rules and Regulations o the Town of Barnstable regarding the above construction. f� Name ................................... ........ :y..... ..... • CLINGHAN, WILLIAM J. A=152-16 No 2.3.28.6..:•.. Permit for .ADD PORCH .s.ingl.e..Family...Dwelling................ . Location ...275„Pine Street West Barnstable .............................................................................. Owner' William J. Clinghari Type of Construction ...Frame Plot ............................ Lot ................................. Permit Granted ...July. 1�,4: ......19 81 c Date of Inspection ............ 19 .Date Completed ........... PER 'IT REFUSED ............................. ............................. 19 ( /. /. ......�. ....................... Approved ..::.......................................... 19 ........................................................ Assessor's map and lot numb r e 4 6�... L--,p ............ INE Sewage' Permit number ]DAR3STAL Hodse number ........................................... ............. . .. ....... r rhea t639. a MAY Ar- TOWN OF BARNSTABLE BUILDING !,NSPECTOR APPLICATION FOR PERMIT TO . . ................................................................. TYPE OF CONSTRUCTION ........ .................. .......... ....19.Z/ TO THE INSPECTOR OF BUILDINGS: The undersigned re applies for a permit accoycling to th following information: ....... ..Location .!��.... . ........ ........11 ............. . .......................... ProposedUse .......... .... ... .=.... .. .. .. .......xaic�..... ........ ................................................................ Zoning District ........................................................................Fire District If Name of Owner II/W..1. ..... . .. ...............Address Name of Builder ..................... . .. .. . ..................................Address .... .0.... .reZ-z".-L-t�- ........... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation Exterior .......0&�..... ............... ......................................Roofing ....... ma Floors ......... . . ................................................Interior ............. ................................................... ...............................................Plumbing ...................;.�. . ......................................... Heating ........... Fireplace .............. ....... ..........................................ApproxiM 115 Do.!.................. .... .pte Cost ............. .... ........ Definitive Plan Approved by Planning Board -------------------—----------19--------- Area .......... pd Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH sT � v. ry I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.. . ........ Name . ....... ............... . ............... CI'INGH&0, VVILLIA!4 J. ~ ADD �����No - Permit �v ----. ---. ' ' � __. � ��..I7 .Siula�d.lv_ '��ell ____. . Location .275 �i�!/�-St���t............. r -- .... - -'. '. ^ West Barnstable - --------------------------. '� ^ . ». Willi J Cli ' ' Owner --..,--��.-_�-_-�������___-. Type of Construction .....�������----.---. . � -----------.----.---.�------. Plot ............................ Lot ................... - . ^ - ~- :--July I4 8I ParmPermit ---.'�---�� � —L...-^lV � . . Dote of | ........ :......-�.lA . . . Dote Completed ................. --lA ' ' , ! PERMIT REFUSED -----,--------------�. l� . ' % . ----------------`---------- . � —.-----.-------------------. .-..-------.....---------~---~.-.�� ~\ � ----~--~^--~----------'---^'` ' ^ ~ ~ ~ Approved lA ---'------------. ^~ . ^ --_----------.-.--.-----.---. . . -.- . ............................................ . ----� .� .. - - ' - Town of Barnstable BU11Cllil Post Th�s,.Card So That it s Visible From the Street-App�roved3P..lans�MustI h. etainedaon Job and this:Card3Nlustvbe Kep �� .gay a Posted Until Final.lnspeetion HasBeen Made. s 'H,od Where a:Cert�ficate of Occupancy=is Required;such"Building shall Not be Occupied§until a_Final Inspection has been made. Permit Permit'NO. 1341-1023 Applicant Name: Mike McMahon' Approvals Date issued: 04/19/2017 Current'Use: Structure Permit,Type: Building-Insulation-Residential Expiration Date: 10/19/2017 Foundation: .Location: 275 PINE STREET'�WEST'BARNSTABLE Map/Lot: 152-016 Zoning District: RF. Sheathing: `��' ContractorNMR a e: MICHAEL T MCMAHON Framing: 1 ` Owner on Record: :CLINGHAN;JANE M ESTATE OF ��... � � � ,� � Address: 27S PINE STREET ContraaOT License , CS-068111 2 WEST BARNSTABLE 4,400.00 MA!02668 - Est Protect Cost: .$ -Chimney: Description:. Weatherization,air-sealing,,weather stripping andblown cellulose � e mite: $85.00 ry, 'Insulation: project Review Req: Weatherization;air sealn ,weather,st 1n gand blown eP 85.00 Final: cellulose Date � � � ,� . 4 19 2017 ... ... .... Plumbing/Gas �} . K . ttfi 7. sr L S iS Rough Plumbing: . � �� Building Official Final'Plumbing: This permit shall be deemed-abandoned and invalid unless the work auth iiddaby this permit is commenced within sasmonthsafter issuance. 1f1ti4� ; -- Rough Gas All work authorized by this permit shall conform to the approved applicattion a the approved construction documenup or which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning bylaws and codes. •.' Final Gas: This permit shall be displayed in location clearly visible from access street orroad and shall be maintained for public mspeetion for the entire duration of the work until the completion of the same. p «" R# y Electrical The Certificate of Occupancy will not be issued until all applicablesignatures by the,Bwlding andYFire Officials are;providedFon this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Ake ro «. Rough: ., 2.Sheathing-Inspection :� ... 3.All Fireplaces must be inspected at the throat level before firest flue.lming is installed Final: 4.Wiring&Plumbing Inspections to be completed-prior to Frame Inspection , 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6-Insulation 7:Final Inspection before Occupancy Low.Voltage Final Where applicable,separate permits are required for Electrical,.Plumbing,and Mechanical lnstaliations. Health Work shallnot proceed until the nspedor has approved the various stages.of construction, final: "Persons contracting with unregistered contractors do not have access.to the guaranty fund" (asset forth in MGL c.142A). Fire Department Building' plans are to be available on-site, Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT I A Town of Barnstable �YEcEPrd �- •. ' 200 Main Street au�ss , Hyannis MA 02601 508-862-4038 Application for Building Permit PA g Application No: TB-17-]1023 Date Recieved: 4/12/2017 Job Location: 275 PINE STREET,WEST BARNSTABLE Permit For: Building-Insulation-Residential Contractor's Name: MICHAEL T MCMAHON State Lic. No: CS=068111 Address: PLYMOUTH, MA 02360 - Applicant Phone: (781) 831-1234 (Home)Owner's Name: CLINGHAN,JANE M ESTATE OF Phone: (508)514-0266 (Home)Owner's Address: 275 PINE STREET, WEST BARNSTABLE,MA 02668 Work Description: Weatherization,air,sealing,weather stripping and blown cellulose _ a r Total Value Of Work To Be Performed: $4,400.00 �. Structure Size: 0.00 0.00 0.00 m . Width. Depth Total Area I hereby swear and attest that I will.require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,'it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Mike McMahon 4/12/2017 (781)831-1234 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost $4,400.00 iDate Paid Amount Paid Cheek#or CC# Pay Type Total Permit Fee: $85.00 ' 4/12/2017 $85.00 XXXX-XXXX-X)M- Credit Card 7015 ._.._.---..................................._.............._..__.__...___.__.•---._.__._..._.,.._..__..........._.._._._._...._........................................._-___--.................. Total Permit Fee Paid: $85.00 AK/1f 7 / /1f7